Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
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Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

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003780407<strong>01</strong> FLUVOXAMINE TAB 25MG 12/31/9999 2<strong>01</strong>2300555096702 FLUVOXAMINE TAB 25MG 12/31/9999 2<strong>01</strong>2342769122200 FLUVOXAMINE TAB 25MG 12/31/2<strong>01</strong>3 2<strong>01</strong>2360505<strong>01</strong>64<strong>01</strong> FLUVOXAMINE TAB 25MG 12/31/9999 2<strong>01</strong>2362559<strong>01</strong>58<strong>01</strong> FLUVOXAMINE TAB 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>850027<strong>01</strong> FLUVOXAMINE TAB 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85002705 FLUVOXAMINE TAB 50MG 12/31/9999 2<strong>01</strong>23003780412<strong>01</strong> FLUVOXAMINE TAB 50MG 12/31/9999 2<strong>01</strong>2300555096802 FLUVOXAMINE TAB 50MG 12/31/9999 2<strong>01</strong>2342769122500 FLUVOXAMINE TAB 50MG 03/31/2<strong>01</strong>4 2<strong>01</strong>23510790992<strong>01</strong> FLUVOXAMINE TAB 50MG 12/31/9999 2<strong>01</strong>2351079099220 FLUVOXAMINE TAB 50MG 12/31/9999 2<strong>01</strong>2360505<strong>01</strong>65<strong>01</strong> FLUVOXAMINE TAB 50MG 12/31/9999 2<strong>01</strong>2362559<strong>01</strong>59<strong>01</strong> FLUVOXAMINE TAB 50MG 12/31/9999 2<strong>01</strong>2300023031604 FML OIN 0.1% OP 12/31/9999 2<strong>01</strong>2311980022805 FML FORTE SUS 0.25% OP 12/31/9999 2<strong>01</strong>2311980022810 FML FORTE SUS 0.25% OP 12/31/9999 2<strong>01</strong>2311980021105 FML LIQUIFLM SUS 0.1% OP 12/31/9999 2<strong>01</strong>2311980021110 FML LIQUIFLM SUS 0.1% OP 12/31/9999 2<strong>01</strong>2311980021115 FML LIQUIFLM SUS 0.1% OP <strong>01</strong>/11/2<strong>01</strong>3 2<strong>01</strong>2300603<strong>01</strong>8621 FOAM ANTACID CHW 80-20MG 09/30/2<strong>01</strong>3 2<strong>01</strong>2324385<strong>01</strong>2678 FOAM ANTACID CHW 80-20MG 12/31/9999 2<strong>01</strong>2324385039740 FOAM ANTACID SUS 12/31/9999 2<strong>01</strong>2300078038205 FOCALIN TAB 10MG 12/31/9999 2<strong>01</strong>2300078038005 FOCALIN TAB 2.5MG 12/31/9999 2<strong>01</strong>2300078038105 FOCALIN TAB 5MG 12/31/9999 2<strong>01</strong>2300078043105 FOCALIN XR CAP 10MG 12/31/9999 2<strong>01</strong>2300078049305 FOCALIN XR CAP 15MG 12/31/9999 2<strong>01</strong>2300078043205 FOCALIN XR CAP 20MG 12/31/9999 2<strong>01</strong>2300078060805 FOCALIN XR CAP 25MG 12/31/9999 2<strong>01</strong>2300078043305 FOCALIN XR CAP 30MG 12/31/9999 2<strong>01</strong>2300078060905 FOCALIN XR CAP 35MG 12/31/9999 2<strong>01</strong>2300078043405 FOCALIN XR CAP 40MG 12/31/9999 2<strong>01</strong>2300078043005 FOCALIN XR CAP 5MG 12/31/9999 2<strong>01</strong>2342192031190 FOLAST TAB 12/31/9999 2<strong>01</strong>2351991007733 FOLBECAL TAB 12/31/9999 2<strong>01</strong>2351991008490 FOLBEE TAB 12/31/9999 2<strong>01</strong>2351991008290 FOLBEE PLUS TAB 12/31/9999 2<strong>01</strong>2351991052890 FOLBEE PLUS TAB CZ 12/31/9999 2<strong>01</strong>2351991038490 FOLBIC TAB 12/31/9999 2<strong>01</strong>2368308035230 FOLCAL DHA CAP 12/31/9999 2<strong>01</strong>2368308026930 FOLCAPS CAP OMEGA 3 12/31/9999 2<strong>01</strong>2368308032410 FOLCAPS TAB 12/31/9999 2<strong>01</strong>2300245<strong>01</strong>5560 FOLGARD OS TAB 12/31/9999 2<strong>01</strong>2300245<strong>01</strong>9111 FOLGARD RX TAB 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>8410 FOLIC ACID INJ 5MG/ML 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>8411 FOLIC ACID INJ 5MG/ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>431248<strong>01</strong> FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43124810 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>439717<strong>01</strong> FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43971710 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>23005915216<strong>01</strong> FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2300591521610 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2300603316202 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2300603316221 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2300603316230 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2300603316232 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2300603371432 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>230090462<strong>01</strong>80 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2310267<strong>01</strong>20<strong>01</strong> FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>23

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